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BACKGROUND: Depression and suicide are among the leading causes of morbidity and mortality, respectively, in adolescents in Hawaii and in the United States overall. Individuals who suffer from depression are at increased risk for having suicidal thoughts and behavior. Social support has protective effects against depression and suicide risk in some populations. An understanding of protective factors that modify the association of depression with suicide risk could be important for public health interventions. We investigated the effects of adult social support on the relationship between depressive symptoms and attempted suicide in adolescents in Hawaii.
METHODS: We examined Hawaii Youth Risk Behavior Survey (YRBS) data from 2013 for public high school students only (N=4,631). To assess depressive symptoms, students were asked “During the past 12 months, did you ever feel so sad or hopeless almost every day for two weeks or more in a row that you stopped doing some usual activities?” Students also were asked how many times they attempted suicide in the past 12 months. To assess adult social support, students were asked if there is an adult who they can talk to if they have a problem, both at school and outside of school (separate questions). There was a significant interaction between adult social support at school and reporting depressive symptoms in predicting attempting suicide. Simple main effects were reported for the associations between depressive symptoms and suicide attempt for each support level at school with adjustment for sex and race. Final logistic regression model for suicide attempt and support outside of school was adjusted for sex, race and depressive symptoms.
RESULTS: Overall, 29.8% of respondents (95% CI=27.5, 32.0) reported depressive symptoms and 10.7% (95% CI=9.2, 12.2) reported attempting suicide. The strength of the association between depressive symptoms and suicide attempt was smaller among students with an adult to talk to at school (AOR=3.96; 2.55, 6.17) compared to those with no adult to talk to at school (AOR=10.57; 6.65, 16.78). Students with an adult to talk to outside of school had lower odds (AOR=0.57; 0.43, 0.76) of suicide attempt, compared to students without adult social support outside of school; but that support did not modify the relationship between depressive symptoms and suicide attempt.
CONCLUSIONS: In Hawaii, adult social support may modify the association between depression and suicide attempt among high-school students. Increasing opportunities for adult social support may improve mental health and decrease the risk of suicide attempt.